Florida Governor Rick Scott has never been one to let facts get in the way of conservative ideology, and recently he’s been trumpeting a lot of untruths about the Affordable Care Act, aka Obamacare. He claims the law’s expansion of Medicaid coverage will cost Florida $1.9 billion a year; it’s actually closer to $500 million. Regardless, Scott is determined not to implement the health reform law, which the U.S. Supreme Court upheld last month while still letting states opt out of its Medicaid expansion. And he’s not alone. At least four other conservative governors, mostly in the South, say their states won’t augment their Medicaid rolls, one of Obamacare’s key provisions for reaching near universal coverage.

You can cut these Tea Party warriors some slack and acknowledge, as my colleague Joe Klein has, that growing a “troubled program” like Medicaid, the joint federal-state system that gets health insurance to the nation’s poorest residents, may not be Obamacare’s smartest idea. The problem is that many of the states rejecting the Medicaid expansion – which the federal government would fund 100% for the first three years starting in 2014, and then gradually decrease to 90% by 2020 – don’t offer much in its stead. Texas, where Governor Rick Perry this week called Obamacare’s reforms “brazen intrusions,” has the nation’s highest rate of uninsured residents, 25%; Florida, at 21%, is right behind it. Never mind: Scott, Perry and their counterparts are standing firm, insisting, as Scott said recently, that “there is no way [we] can pay for” Obamacare.

Scott’s doctrinaire defiance is politically risky for the Republican Party. Florida is arguably the most important swing state in November’s presidential election – and GOP candidate Mitt Romney trails President Obama, who won the Sunshine State in 2008, by four points there in the most recent Quinnipiac voter poll, 41% to 45%. The Republican National Convention will be held in Tampa, Fla., at the end of August; but Scott, whose dismal approval ratings make him one of the nation’s least popular governors, is widely considered a potential drag on the GOP’s fortunes. The big question now is whether his Obamacare position stands to make him a heavier electoral millstone or a conservative buoy for the Romney campaign.

Scott, a former health care corporation CEO, took office 18 months ago after spending $75 million of his own fortune on his 2010 campaign. Since then, his approval ratings have sunk as low as the 20s, largely because of a sense among Florida voters that he’s more concerned with building his dogmatic agenda – like refusing some $2 billion in federal high-speed rail funds or barring pediatricians from inquiring about guns in their patients’ homes, a Scott-backed law that a federal judge just struck down as unconstitutional – than he is with tending to the peninsula’s economic wreckage. Health care reform could turn out to be a consequential issue in Florida, not only in terms of insurance but also jobs, the one problem Scott pledged to fix during his campaign.

For the moment, Scott’s Obamacare stance looks to be on political terra firma. Polling on health care reform can swing depending on how the questions are asked, but in a SurveyUSA poll taken in Florida taken right after the Supreme Court ruling, half those surveyed disagreed with upholding Obamacare while only 39% agreed. More important, 54% of independent voters, a large and critical bloc in Florida, disagreed and only 36% agreed. Still, support nationwide for Obamacare has grown since the ruling, and presidential elections in Florida are unpredictable at best (see Y2K). Scott is rolling the dice – galvanizing the conservative base in the peninsula’s northern tier while angering liberal voters in more heavily populated South Florida.

Matthew Corrigan, who is political science chairman at the University of North Florida in Jacksonville and has published studies on health care reform, says that while he does not think Scott’s Obamacare stance “will have a huge impact in the aggregate, the Obama campaign will use it to get turnout up in places like Broward and Miami-Dade Counties, where people will be more likely to see it as uncaring toward middle-class and working-class voters.” There, Corrigan notes, the state’s high level of uninsured matters more, especially when Obamacare could add 1 million poor Floridians to the Medicaid rolls. So does the fact that the state has the nation’s second worst level of coverage for children and some of the nation’s most restrictive criteria for Medicaid eligibility.

A key question, of course, is how many of those 1 million people vote. But there are broader economic and jobs concerns. One of the reasons Scott’s refusal of high-speed rail money was so unpopular was that it could have funded as many as 30,000 jobs. The state is still recession-racked, its unemployment rate only recently dipped below 9%, and the project would have bolstered the sort of high-tech sector that Florida’s low-wage economy desperately needs.

Health care, meanwhile, is one rare high-wage industry that’s thriving in Florida, and the Medicaid expansion could bring more than $20 billion in federal funding between 2014 and 2024, according to the liberal Florida Center for Fiscal and Economic Policy in Tallahassee. The FCFEP estimates it would create 65,000 private-sector jobs over six years. That cash and employment, argues FCFEP Director Karen Woodall, will just go to other states now. “The Governor is sticking to an ideological position,” says Woodall, “that’s not just harmful to uninsured people, but the economy as a whole.”

Which may be partly why Republican leaders in Florida’s GOP-controlled state legislature are taking a more “rational and deliberative” approach, according to incoming state House Speaker Will Weatherford. He and incoming state Senate President Don Gaetz oppose Obamacare – but Gaetz recently said the legislature will be “tweezering through the [Supreme Court] opinion to determine what Florida’s options and obligations are,” while Weatherford has said the body has to “recognize that [Obamacare] has been upheld.” Other Florida GOP leaders have said they want the state to set up its own health insurance exchanges instead of using one established by the federal government, which will happen if Florida does nothing.

All the GOP lawmakers hope that they don’t have to confront the issue at all – that Republicans will win the White House and Congress and repeal Obamacare outright before the legislature’s next full session in March 2013. But they first have to get Romney elected – which may require winning Florida, which in turn may require Florida Republicans to show a more moderate face on Obamacare than Scott’s. They may also realize in the end that Scott’s own health care history – in 1997 he resigned as CEO of his corporation, Columbia/HCA, after it was busted for massive Medicare fraud (though he wasn’t charged personally) – doesn’t exactly give him moral authority in voters’ eyes. Per usual when it comes to Scott, the GOP will be doing risk control between now and November.